Thyroid disease, including autoimmune genesis, and diabetes mellitus are the two most common endocrine diseases in clinical practice. These pathologies have a mutual influence on each other. On the one hand, thyroid hormones are involved in regulation of carbohydrate metabolism: excessive production of thyroid hormones is associated with hyperglycemia, while hypothyroidism has a decreased level of glucose production by the liver. On the other hand, glucose homeostasis disorder affects the functional state of the thyroid gland: dystrophic, sclerotic and atrophic processes are developing in thyroid gland, what is a manifestation of diabetic microangiopathy. This article demonstrates the need to take into account the mutual influence of pathologies for optimal treatment of this conditions.
Акромегалия -тяжелое мультифакториальное нейроэндокринное заболевание, обусловленное наличием аденомы гипофиза, в избытке продуцирующей гормон роста (ГР) и опосредуемого им инсулиноподобного фактора роста 1 (ИФР-1). Чрезмерное повышение ИФР-1 обусловливает развитие характерной клинической картины акромегалии: диспропорционального роста костей, хрящей, мягких тканей и внутренних органов, нарушения морфо-функционального состояния сердечно-сосудистой системы, различных видов метаболизма. Широко известными свойствами ИФР-1, обусловливающими способность увеличивать пролиферативный потенциал клеток, являются его митогенная и анти-апоптотическая активность. Возникновение новообразований щитовидной железы различного потенциала злокачественности, являясь яркой иллюстрацией избытка ИФР-1 в клинической картине акромегалии, представляется логичным и, в некоторой степени, закономерным осложнением этого нейроэндокринного заболевания. Однако одновременное сосуществование у пациента трех эндокринных патологий -акромегалии, папиллярного рака щитовидной железы (РЩЖ) и, неожиданно, диффузного токсического зоба (ДТЗ) -является исключительной редкостью и представляет значительный интерес.Существует немало вопросов относительно достоверной оценки риска возникновения новообразований щитовидной железы у пациентов с акромегалией. В ряде исследований неоднократно показано увеличение частоты диффузного нетоксического и узлового зоба при
BACKGROUND: Adrenocortical cancer (ACC) is an orphan malignant tumor of the adrenal cortex with a predominantly poor prognosis and an aggressive clinical course. Nowadays, mitotane is a non-alternative drug in the treatment of ACC. The search for prognostic parameters that determine the sensitivity of ACC to ongoing treatment is currently an urgent task. Expression levels of the large subunit of ribonucleotide reductase M1 (RRM1), cytochrome P450 2W1 (CYP2W1), and sterol- O-acyltransferase-1 (SOAT1) are considered as potential predictors of response to mitotane therapy.AIM: To assess the immunohistochemical expression of RRM1, CYP2W1 and SOAT1 in ACC as markers of clinical outcomes and response to the therapy with mitotane.MATERIALS AND METHODS: The study included 62 patients older than 17 years of age with a diagnosis of ACC confirmed histologically and immunohistochemically. Mitotane therapy was initiated in 29 patients in the postoperative period, 33 patients were under dynamic observation without concomitant drug treatment. Antibodies to RRM1, CYP2W1, SOAT1 were used diluted in accordance with recommendations of firms-manufacturers for immunohistochemical detection. RESULTS: In the group of patients with low and moderate RRM1, CYP2W1 and SOAT1 immunoreactivity in the tumor and no antitumor therapy, a better DFS was noted (p=0.037, p=0.020 and p=0.001, respectively) compared to the group of patients receiving mitotane therapy at this level of marker expression. With high immunoreactivity of the markers, no statistically significant differences in DFS were found.CONCLUSION: Consistent with the findings in our study, low expression of RRM1, CYP2W1 and SOAT1 was associated with worse DFS with antitumor therapy. The results of the work indicate the need to assess the levels of immunoreactivity of these markers in patients with ACC before starting treatment with mitotane in order to predict the efficiency of therapy.
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